Adams Public Defender Application Form PDF Details

The Adams County Public Defender Application is required for people facing criminal charges who need legal representation but cannot afford a private attorney. Qualifying applicants receive a court-appointed attorney at no cost.

What Information the Form Requires

The form collects personal details including your name, date of birth, Social Security number, address, and phone number. You also provide case-specific data such as the case number, the charges you face, the name of the Magisterial District Judge, any co-defendants, bail amounts, and upcoming court dates including the type of proceeding.

Financial Disclosure Requirements

A complete financial picture is required to confirm eligibility. The form asks about your employment status, income, government assistance such as welfare or unemployment benefits, and any savings or real estate you own. This information determines whether you qualify for a public defender. If you need to document your income in more detail, a separate financial affidavit form may also be useful.

Honesty and Accuracy Are Required

The application demands complete honesty. You must disclose your marital status, any probation or parole status, and your prior criminal record. Write clearly in every field. Illegible or incomplete answers can cause delays in your case. If a field does not apply, write "N/A" rather than leaving it blank. There is also a section to indicate if you need an interpreter and which languages you speak.

Related Legal Forms

Depending on your situation, you may need additional documents. People dealing with other legal matters can find a residence legal application in our library. You can also view the Pennsylvania standard application for other statewide filing needs, or browse our complete collection of legal templates.

QuestionAnswer
Form NameAdams Public Defender Application Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesMagisterial, SSD, PENNSYLVANIA, adams public defender application

Form Preview Example

Date of Application:

Case Number:

ADAMS COUNTY PUBLIC DEFENDER APPLICATION

Please print and fill in the application completely. delays will result if information is not legible. If you receive any other new charges, you must re-apply for every charge. Please bring all of your legal paperwork and most recent 3 pay stubs with you.

Last Name:

 

 

First Name:

 

Middle Name:

Alias:

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

Driver's License #:

 

 

 

Driver's License State:

Social Security #:

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

State:

 

 

Zip Code:

 

Phone # (home):

 

 

 

 

 

 

 

(cell):

 

 

 

 

 

 

Interpreter Needed:

Yes

No

Language:

 

 

 

 

 

 

Please place a check next to all that apply:

you are here for:

 

 

 

 

 

Criminal Charges

 

 

 

Parole/Probation/IPP Violation

 

Appeal Issues

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What are your charges:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Who else was involved:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Magisterial District Judge:

 

 

 

 

 

 

 

 

 

 

 

 

Current bail amount for all charges:

 

 

 

 

 

Next Court Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

Time:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type (Check one):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preliminary Hearing

 

Waived Preliminary Hearing

 

Arraignement

 

 

Pre-Trial Conference

Plea

Trial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have any other pending charges:

 

 

 

 

 

Yes

 

 

 

 

No

 

Charges:

 

 

 

 

 

 

If Yes, please explain and name your attorney:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have a prior adult criminal record:

 

 

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you presently on probation or parole:

 

 

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marital Status:

 

 

 

 

 

 

 

 

 

 

 

 

Number for Children:

 

 

 

 

 

 

 

 

Ages:

 

 

 

 

 

Are you a US Citzen:

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you currently employed:

 

Yes

 

 

 

 

 

No

 

 

 

Where:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weekly Net Pay:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Savings/Checking account balance:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you receive SSI/SSD:

Yes

 

 

 

 

No

 

Monthly amount:

 

 

 

 

 

 

 

 

 

 

 

 

Does your Spouse/live-In/Significant Other work:

 

 

 

Yes

 

No

 

Where:

 

 

 

 

 

 

His or Her Savings/Checking account balance:

 

 

 

 

 

 

 

 

 

 

 

 

SSI/SSD:

 

 

 

 

 

 

Does anyone in household currently receive:

 

 

 

 

 

Welfare

 

Unemployment

Other

 

Amount:

 

 

 

 

 

 

 

 

 

 

 

 

How often:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Real Estate Owned:

 

 

 

 

 

 

 

 

 

Valued:

 

 

 

 

 

 

Mortgage Balance:

 

 

is there anybody with whom we have your permission to speak with regarding your case:

 

 

 

Yes

No

If yes, what is their name and relation to you:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do we have permission to speak to the:

 

 

District Attorney

 

Assistant District Attorney

 

 

Prosecuting Officer or

District Judge regarding your case prior to our first appearance on your behalf:

THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA

CRIMINAL

COMMONWEALTH OF PENNSYLVANIA

Criminal Action

Vs.

Case No.

 

 

ALL QUESTIONS MUST BE ANSWERED AND THE AFFIDAVIT COMPLETED BEFORE THE COURT WILL ACT ON THE PETITION.

COMMONWEALTH OF PENNSYLVANIA

: SS.

COUNTY OF ADAMS

:

……………………………………………………………………………………., being duly sworn according to

law, upon (his) (her) oath, deposes and says:

1.I am the petitioner in the above entitled action.

2.I have read the foregoing petition and know the contents thereof and the same are TRUE to my own knowledge, except as to matters therein stated to be alleged as to persons other than myself, and, as to those matters I believe it to be true.

3.This affidavit is made to inform the Court as to my status of indigence and to induce the Court to assign counsel to me as an indigent defendant for my defense against the criminal charges that have been made against me.

4.In making this affidavit I am aware that PERJURY is a felony and that the punishment is a fine of not more than $15,000 or imprisonment for not more than seven years or both.

5.I understand that I must advise the Court immediately of any material change in my financial circumstances such as but not limited to, and increase of wages or new employment.

Signature of Defendant

FOR OFFICE USE ONLY

INTERVIEWER'S NOTES:

PRELIMINARY HEARING

 

 

 

 

 

ARRAIGNMENT

 

 

 

PRE-TRIAL CONFERENCE

 

PLEA

 

 

 

TRIAL TERM

 

IPP VIOLATION

 

 

 

 

 

 

PROBATION/PAROLE VIOLATION

 

 

 

PFA CONTEMPT

 

 

 

 

 

 

SUMMARY

 

 

 

 

 

 

RULE 456

 

 

 

 

 

 

BAIL REDUCTION

 

 

 

 

 

 

SUPERVISED BAIL

 

 

 

 

 

 

SEND STENO

Yes

No

APPEAL

 

 

 

 

 

 

PCRA

 

 

 

 

 

 

Notes

How to Edit Adams Public Defender Application Form Online for Free

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Step 1: Simply click the "Get Form Button" at the top of this page to open the PDF editing tool. Here you will find everything that is necessary to work with your document.

Step 2: Once you launch the PDF editor, you will notice the document ready to be filled out. Other than completing the blank fields, you can also add text, modify existing content, insert your signature, and more.

This document requires specific information. To ensure accuracy and reliability, please follow the guidance below.

1. Complete the Adams Public Defender Application carefully, paying close attention to all of these fields:

Part no. 1 of filling in adams county public defender application

2. The next part is to fill out these blanks: Other, What are your charges, Who else was involved, Magisterial District Judge, Next Court Date, Type Check one, Current bail amount for all charges, Time, Preliminary Hearing, Waived Preliminary Hearing, Arraignment, PreTrial Conference, Plea, Trial, and Do you have any other pending charges.

adams county public defender application conclusion process shown (part 2)

3. Completing the spousal and household financial section is essential for the next step. Fill out Does your Spouse/Significant Other live with you, savings and checking account balances, SSDI or SSD benefits, household assistance programs including welfare or unemployment, amount of income, real estate owned, property value, and mortgage balance. Do not skip any details.

Does your SpouseliveInSignificant, is there anybody with whom we have, and Mortgage Balance in adams county public defender application

4. Filling out the Commonwealth of Pennsylvania declaration section is required in the fourth part. Complete fields for Criminal Action, Case No, the statement that all questions must be answered and certified, the petitioner declaration, and the affidavit confirmation. Be patient and complete every blank field accurately.

Criminal Action, ALL QUESTIONS MUST BE ANSWERED AND, and I am the petitioner in the above inside adams county public defender application

Be extremely careful when completing the Criminal Action field and the certification statement, as these are the sections where mistakes are most common.

5. When you reach the end of the document, one final step remains. You must provide the Signature of Defendant to complete the application.

adams county public defender application completion process explained (portion 5)

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